Total Positive Margin Length as a Novel Prognostic Indicator After Radical Prostatectomy

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Positive surgical margins (PSMs) after radical prostatectomy (RP) are linked to biochemical recurrence (BCR), but their prognostic impact varies.
• Current risk stratification may not fully capture the variability in BCR risk among patients with PSMs.

Purpose of the Study:

• To investigate if detailed analysis of margin characteristics can enhance postoperative risk stratification for BCR after RP.
• To identify specific PSM features that are most predictive of recurrence.

Main Methods:

• Retrospective review of 1003 patients undergoing RP without neoadjuvant/adjuvant therapy.
• Categorization of PSMs based on total length, maximum length, primary Gleason pattern (pGP), multifocality, and location.
• Analysis of other pathological factors including T/N stage, ISUP grade group, and intraductal carcinoma of the prostate (IDC-P).

Main Results:

• PSMs were identified in 37.4% of patients.
• Total PSM length and pGP at the margin were the strongest predictors of BCR.
• A risk stratification model using total PSM length (>5 mm) and pGP4-5 at the margin effectively stratified BCR risk in organ-confined disease with PSMs.

Conclusions:

• A risk classification incorporating total PSM length and pGP at the margin significantly improves postoperative prognostic stratification for localized prostate cancer with PSMs.
• Total PSM length may be more informative than maximum PSM length for predicting BCR in cases with multiple PSMs.